From the Guidelines
For a 51-year-old male with bacterial sinusitis, the recommended first-line antibiotic treatment is amoxicillin-clavulanate at a dose of 80 mg/kg/day in three doses, not exceeding 3 g/day, as per the official French guidelines 1. This recommendation is based on the most recent and highest quality study available, which suggests that amoxicillin-clavulanate is effective against common sinusitis pathogens.
- The standard duration of treatment is 7±10 days, as recommended by professional consensus 1.
- Alternative antibiotics, such as cefpodoxime-proxetil at a dose of 8 mg/kg/day in two doses, may also be considered 1.
- It is essential to note that amino-penicillins, macrolides, first-generation cephalosporins, and cotrimoxazole are no longer recommended due to the prevalence of resistance 1.
- Additionally, corticosteroids may be used as adjuvant therapy in acute hyperalgic sinusitis for a short period, but the efficacy of NSAIDs at anti-inflammatory doses has not been demonstrated in sinusitis 1.
From the FDA Drug Label
1.4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis Levofloxacin is approved for the treatment of acute bacterial sinusitis (ABS) using either 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days
The recommended antibiotic and dose for a 51-year-old male with bacterial sinusitis is levofloxacin. The dose can be either 750 mg once daily for 5 days or 500 mg once daily for 10 to 14 days 2.
From the Research
Recommended Antibiotics for Bacterial Sinusitis
- Amoxicillin is a commonly recommended antibiotic for patients with uncomplicated sinusitis, especially in areas where the prevalence of beta-lactamase-producing pathogens is less than 20% 3.
- For patients who do not respond to amoxicillin or in areas with a high prevalence of beta-lactamase-producing bacterial species, alternative antimicrobials include:
- Amoxicillin-clavulanate
- Erythromycin-sulfisoxazole
- Trimethoprim-sulfamethoxazole
- Cefaclor
- Cefuroxime axetil
- Cefixime 3
Dosing Recommendations
- High-dose amoxicillin (80-90 mg/kg/day) is recommended for initial therapy 4.
- The adult dose of amoxicillin for the treatment of acute maxillary sinusitis can be increased from 1.5 g/day to 4.0 g/day to overcome the growing resistance of Streptococcus pneumoniae to penicillin 5.
- Amoxicillin-clavulanate can be given orally every 12 hours (amoxicillin, 875 mg; clavulanate, 125 mg) or every 8 hours (amoxicillin, 500 mg; clavulanate, 125 mg) for 14 days, with similar clinical success rates 6.